A 21st century nosocomial issue with endoscopes

Abstract

On 3 January 2014 the results of a year long investigation by the US Centers for Disease Control (CDC) into an outbreak of New Delhi metallo-β-lactamase (NDM)-producing carbapenem resistant Enterobacteriaceae (CRE) were released. Of 69 patients with confirmed CRE infections, 29 went to Advocate Lutheran General Hospital (ALGH) for the same procedure-an endoscopy. 1 The endoscopy itself is not dangerous, but the current cleaning process used between procedures leaves patients susceptible to infection and troubles many healthcare practitioners.With more than 18.6 million gastrointestinal endoscopies and at least a half million bronchoscopies every year in the US alone, 2 medical practitioners must take the utmost care during the cleaning process between patients, especially with the emergence of superbugs such as CRE. But the safety profiles of the cleaning protocols are less than acceptable in preventing life threatening outbreaks. The endoscopes are frequently the means for facilitating pathogenic cross contamination between patients-making the case at ALGH far from unique.The threat of cross contamination may not be visible to a clinician from personal experience alone, but broader and more comprehensive studies show that the cleanliness of endoscopes varies greatly. A mid 2013 study reported that about 15% of endoscopes in US hospitals failed to achieve an accepted standard of cleanliness after liquid reprocessing (the prevailing disinfection process used between patient procedures). 3 In this study, duodenoscopes were the dirtiest at a 30% contamination rate, and colonoscopes were the cleanest at a 3% contamination rate. 3

First clinical evaluation of a new single-use flexible cystoscope dedicated to double-J stent removal (Isiris™): a European prospective multicenter study

“…The other issue addressed is the risk of urinary tract infection after flexible cystoscopy. Flexible cystoscopes mostly undergo high level disinfection (HLD) rather than sterilization between patients [20]. Thus, the question of pathogenic cross contamination between patients is addressed given that there is now an alternative with this single use cystoscope.…”

A Prospective Audit of Urinary Tract Infection Incidence Following the use of Endosheath® for Flexible Cystoscopy

“…It has a less labour-intensive process with less handling and eventually less need for repairs. 17 There are some limitations to this study. The level of clinical experience and clinical role of individual cystoscope operators was not documented, and thus clinical and technical experience could not be evaluated as a variable in the analysis.…”

Investigation and invention in carbapenem-resistant Klebsiella pneumoniae infection cases associated with Endoscopic retrograde cholangiopancreatography operation

“…ERCP is a valuable technique that is widely performed worldwide (7), and more than 18.6 million gastrointestinal endoscopies were performed in the USA (17). Noronha et al revealed that the endoscopes would be considered as the source of nosocomial infection in the twenty-first century (18). Hence, microbiological culturing, EO sterilization, liquid chemical sterilization, and repetition of high-level disinfection were recommended to reduce the risk of infection transmission associated with ERCP (19,20).…”